MEDICARE: MRS. LOUISE MARIE POTHIER RNFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant	160516	MA

General Provider Information

NPI Number	:	1689790883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOUISE MARIE POTHIER RNFA

Provider Business Mailing Address
First Line	:	115 CHESTNUT ST
Second Line	:
City	:	NORTH READING
State	:	MA
Zip	:	01864-2822
Country	:	US
Telephone Number	:	978-664-5521
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 WOODLAND RD STE 212
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-1711
Country	:	US
Telephone Number	:	781-662-2288
Fax Number	:	781-662-7546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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